CVS Health Research Institute examines tools to slow cost growth of specialty meds

WOONSOCKET, R.I. — As specialty drug spending continues to rise and is predicted to grow by more than 16% annually from 2015 to 2018, CVS Health researchers examine the reasons for such dramatic increases in spending and discuss tools to help manage these escalating costs in an article published in the October issue of Health Affairs. 



CVS Health data shows that between 2012 and 2013, spending on specialty drugs increased by 15.6%, while spending on traditional medications grew by only 0.8%. As noted, this trend is only expected to increase, with specialty drug spending predicted to grow by more than 16% annually from 2015 to 2018, ultimately accounting for approximately $235 billion, or more than 50%, of total drug spending by 2018.



“As specialty drugs begin to address the needs of an increasingly broad range of patients across several therapeutic areas, there is a growing need for solutions that drive the best patient outcomes at the lowest costs,” stated Alan M. Lotvin, EVP, CVS/specialty at CVS Health.  “Significant opportunities exist to bend the cost curve of specialty medications by eliminating waste, inducing price competition and reducing or preventing costly complications.”



The article outlines drivers of rising costs, including the increasing complexity and effectiveness of new medications, the changing dynamics of target populations that broaden the pool of patients eligible for treatment and how and where specialty medications are delivered. It examines how approaches that have been successful in managing cost growth for traditional medications over the past 10 years could be applied to specialty medications, while ensuring adherence to clinical guidelines.



“Spending growth in specialty drugs is not a given,” stated Troyen A. Brennan, chief medical officer at CVS Health.  “To slow cost growth, payers must be willing to embrace a variety of strategies used to manage traditional medications as well as some novel approaches that will require a multi-faceted and holistic approach including the collaboration of those who prescribe, dispense, deliver, pay for, and receive specialty medications.”



The authors share insights into cost management strategies that can help achieve the goal of balancing positive health outcomes with reducing sky-rocketing costs. These include applying traditional drug management plan design elements such as prior authorization and step therapy based on evidenced-based medicine, implementation of tiered formularies to stimulate price competition, and utilization of the lowest-cost site of care for delivery and administration of specialty medications.